Acupuncture in ancient China: How important was it really?

This historical study revolutionizes our understanding of the role of acupuncture in traditional Chinese medicine, questioning the widely accepted belief that needle therapy has always been central to Chinese medical practice. The author Hanjo Lehmann conducted a meticulous analysis of historical records, classical texts, and imperial documents spanning more than two millennia of Chinese history. The investigation reveals a surprising reality: although acupuncture theory is fundamental in the Huangdi Neijing, its clinical application in ancient China was consistently limited and marginalized. The analysis of 400 Chinese emperors throughout history shows that fewer than five were treated with acupuncture, a statistically insignificant number considering that emperors had access to the best physicians and treatments available.

Even in the case of Emperor Renzong of the Song Dynasty, who supposedly valued acupuncture, the reports are questionable and may be legendary. The study of the Shanghanlun, a classical work by Zhang Zhongjing, reveals that among its 398 sentences, only 9 directly recommend the use of normal acupuncture, while many others warn about its dangers. Curiously, none of the three main points of modern acupuncture (ST-36 Zusanli, LI-4 Hegu, and SP-6 Sanyinjiao) is mentioned in the text, with LR-14 Qimen being the most frequently recommended point. Since 81 BC, there are consistent records of warnings about the dangers of acupuncture.

Wang Tao, in the 8th century, wrote that 'acupuncture can kill healthy people and cannot revive those who are dead.' These concerns were justified by the lack of anatomical knowledge and the absence of disinfection techniques, making the procedure risky for both patients and practitioners. The legal situation also discouraged the use of acupuncture: physicians were held responsible for patients' deaths, and with acupuncture, the responsibility fell entirely on those who handled the needles. The definitive milestone occurred in 1822, when Emperor Daoguang permanently banned acupuncture and moxibustion from the Imperial Medical Academy, declaring that they were 'inappropriate to be applied to the Emperor.' This decision, made by respected physicians and scholars after centuries of experience, faced no significant protests, suggesting consensus on the therapeutic limitation of the technique. Xu Dachun had called acupuncture a 'lost tradition' in 1757, indicating its decline long before the official ban.

After 1822, acupuncture became extremely rare in China, being used only in emergencies. During the years in Yan'an (1936-1945), it was practically not used, and there are no records of President Mao having received acupuncture treatment. The 'New Acupuncture' developed after 1954 by Zhu Lian and others essentially represents a complete reinvention of the practice. This modern version incorporates scientific anatomical knowledge, sterilization techniques, stainless steel needles, standardized protocols, and different point selections.

The study concludes that the best era of acupuncture was not during the ancient Song or Yuan dynasties, but rather is now, with practices grounded in scientific evidence and modern safety protocols.